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Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities
Open accessAbstract
Objective To review the histogenesis of peritoneal, ovarian, and rectovaginal endometriotic lesions.Design The comparison of morphologic, morphometric, and histochemical data observed in each type of lesion.Setting A university hospital department of gynecology.Patient(s) Patients complaining of infertility or pelvic pain with laparoscopically proved endometriosis.Intervention(s) Laparoscopy was performed, and biopsy specimens from the endometriotic lesions were histologically studied.Result(s) Three types of endometriotic lesions must be considered: peritoneal, ovarian, and rectovaginal. Morphologic and morphometric data show similarities between eutopic endometrium and red peritoneal lesions, suggesting that these lesions are the first stage of early implantation of endometrial glands and stroma. After partial shedding, the red lesions regrow constantly. The shedding induces an inflammatory reaction, provoking scarification, and the lesions become black. The subsequent fibrosis leads to areas of white opacification that are inactive. The pathogenesis of ovarian endometriomas is a source of controversy. Although there seems to be a consensus concerning the invagination theory, there is still a contradiction between the implantation theory and the metaplasia theory. We recently showed that the mesothelium covering the ovary can invaginate into the ovarian cortex, pushing back the primordial follicles. The presence of mesothelial invagination in continuum with endometriotic tissue suggests that metaplastic histogenesis of ovarian endometriotic lesions occurs. Rectovaginal endometriotic nodules must be considered adenomyomas, consisting of smooth muscle with active glandular epithelium and scanty stroma. Immunocytochemical results show poor differentiation and hormonal independence of these lesions and indicate a close relation with their mesodermal müllerian origin.Conclusion(s) Peritoneal, ovarian and rectovaginal endometriotic lesions must be considered as three separate entities with different pathogeneses.
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In the citing paper
“On gross inspection, endometriosis is subdivided into three categories: superficial peritoneal endometriosis, deeply infiltrating endometriosis (DIE) and ovarian (cystic) endometriosis (Brosens et al., 1993;Koninckx et al., 1994;Nisolle and Donnez, 1997; Table I).”
From Chronic pelvic pain and endometriosis: translational evidence of the relationship and implications (2011) · cites this paper as Nisolle and Donnez, 1997
In the citing paper
“endometriosis, a common chronic inflammatory disease causing pain and infertility [1,2,3]”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [2]
In the citing paper
“the impact of estradiol (E2), which is known to have proinflammatory and antiapoptotic effects on endometrial cells, especially in ectopic foci [2,3]”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [2]
In the citing paper
“Biochemical, histological and clinical evidence show that estrogens play a critical role in the pathogenesis of endometriosis”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [2]
In the citing paper
“although dysmenorrhea and chronic non-menstrual pelvic pain are the most prevalent [2]”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [2]
In the citing paper
“There are three distinct forms of the disease (peritoneal, ovarian and rectovaginal endometriosis)”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [2]
In the citing paper
“post-operative recurrence is common, because persistent foci not detected at the time of surgery may progress under the influence of circulating estrogens [1,2,3,5,6].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [2]
In the citing paper
“We would advocate a strategy based on the different phenotypes of endometriosis, clearly recognized as three separate entities since the original publication by Nisolle and Donnez in 1997 [2].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [2]
In the citing paper
“DE is quite different from OE or PE2 and its histology resembles that of uterine adenomyosis6.”
From Neuropeptides Substance P and Calcitonin Gene Related Peptide Accelerate the Development and Fibrogenesis of Endometriosis (2019) · cites this paper as [2]
In the citing paper
“Clinically, typical cystic and deep endometriosis lesions, thus seem to be three different end points as suggested previously (22,67).”
From Pathogenesis of deep endometriosis (2017) · cites this paper as [22]
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Metadata
- Authors
- Nisolle, M., & Donnez, J.
- Affiliations
- Cliniques Universitaires Saint-Luc (BE)
- ORCID
- Nisolle, Michelle
- Venue
- Fertility and Sterility
- Publisher
- Elsevier BV
- Published
- 1997-10
- Volume
- 68
- Issue
- 4
- Pages
- 585-596
- ISSN
- 0015-0282 (ISSN-L)
- OpenAlex
- W2118366474
- Cited by
- 1,279
- References
- 96
- Citations by year
- 2026: 32 · 2025: 49 · 2024: 50 · 2023: 62 · 2022: 74 · 2021: 67 · 2020: 84 · 2019: 51 · 2018: 54 · 2017: 66 · 2016: 39 · 2015: 38 · 2014: 48 · 2013: 40 · 2012: 44
- FWCI
- 4.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Fertility and Sterility (publishedVersion)
- PubMed (publishedVersion)
- Open Repository and Bibliography (University of Liège) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Ectopic Pregnancy Diagnosis and Management
- Keywords
- peritoneal endometriosis, endometrioma, adenomyoma, endometriosis pathogenesis, histogenesis, metaplasia, Müllerian origin, immunocytochemistry, infertility, pelvic pain
- MeSH terms
- Endometriosis, Female, Humans, Ovarian Diseases, Peritoneal Diseases, Rectal Diseases, Vaginal Diseases
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